Postures To Prevent And Relieve Back Pain in dentistry

This is a brief article to highlight some simple yoga postures which help to relieve current back pain and help to prevent future occurrences.

Uttanasana And Variations

Michelle Middleton is currently still at Chester Hospital as a Maxillofacial SHO, she graduated with Hons in July 2012 from Birmingham University, at the same time as completing her yoga teacher training diploma (level 4). Michelle has taught in Virgin Active gyms and yoga studios and is about to start teaching yoga at the Bank of America Nuffield Health Gym in Chester.

There are common problem areas in dentistry, one of which is the lumbar spine. This can be from sitting or standing, (as a student observing, perhaps) in one position for too long, causing tension to develop.

Not to labour the point too much, but as the pain results from compression in this area of the spine, it needs to be stretched out. One posture in particular is excellent for relieving this tension, and it does not require a lot of space or preparation, and can be modified in many ways to suit your own flexibility and working environment. It is the standing forward bend, also known as Uttanasana. It is shown in Figure1, below.

Figure 1 Uttanasana and variations

Stick man B is the classical pose, the rest are variations. However, here are some preparation and guidance notes so you enter and release the pose correctly and gain the most benefit:

Start standing: feet parallel and hip width apart (feet and legs together works more into the hamstrings and is technically more difficult).

Engage the abdominal muscles by bringing navel to spine and tucking the tailbone inwards. (Clench the abdominal muscles as you would for a sit up but don't hold your breath.)

Stand tall, rolling the shoulders back and down so you're not hunching

To enter the forward bend (classical), start with hands on the hips (this helps to keep the shoulders back), and keeping the abdominals engaged, bend forward at the hips, imagining you are bending at 90 degrees to the floor, like a hinge joint. Keep the back straight, if you feel your shoulders or back start to round, stop.

Once you feel you cannot bend anymore without rounding the spine, bend the knees (whilst keeping the back straight and keeping the abdominal muscles engaged) and aim to get the chest and thighs touching. Do not think about getting the head to the knees!

Once chest and thighs touch, you can take the hands to the floor / other variation, as in Figure 1 above (some prefer to wrap the hands around the back of the legs). You may already feel a stretch in the lumbar spine at this stage.

·You can then try to straighten the legs very slowly and gently. Keep chest and thighs together as much as possible. You may not get much straightening in the legs but you should feel lengthening in the tailbone area, as well as the hamstrings.

Every time you exhale, try to relax more into the posture and try to lengthen the legs a little more.

See Figures 2 and 3 (below) for a diagrammatic summary of the above.

Figure 2 Entering Uttanasana

Figure 3 Entering Uttanasana (2)

Stay as long as comfortable in the posture as possible, aim for 30 seconds to 1 minute at a time. To come out of the posture, try to reverse the way you went into it. Place hands on hips, engage the abdominal muscles and use core strength to 'unhinge', keeping the back nice and straight. Often in exercise classes students are told to roll up like a rag doll, though this will not do any favours for your posture.

Modifications and variations

Stick man A: before forward bending, interlock the hands behind the back (or you can hold onto each of the elbows). This helps to keep the shoulders from rounding and keeps the chest open. Once in the forward bend, instead of taking the hands to the floor, keep the hands interlinked and try and push the hands away from the back. This helps to relieve shoulder tension as well.

Stick man C: before bending forwards at the hips, cross / fold the arms, then lift them above your head, so your elbows are crossed over your head. When in the forward bend you can focus on letting the elbows sink closer to the floor instead of taking the hands down.

Stick man D: this is staying half way and instead of taking hands to the floor (which can round the shoulders a lot in some cases), taking them onto the thighs or shins (try not to place directly on the knee caps)

Additionally you may wish to fold forwards at the hips and then rest your hands on a chair at shoulder height (see Figure 4 below)

Figure 4 Uttanasana modification with chair

Some points to remember

Don't do this immediately after eating or drinking. Wait at least an hour or you may have some reflux!

Having the head below the heart will increase the heart rate and breathing a little so allow your breathing to speed up if necessary and do not be alarmed. You may feel quite hot if you stay in the pose for a while.

If you have high blood pressure take your time going in and out of the pose, or maybe only stop half way. Entering and leaving the pose rapidly may lead to dizziness and fainting in severe cases.

If you have blocked sinuses / sinusitis you may get some discomfort. If so come out immediately.

Do daily for maximum benefit!

Additional benefits (aside from stretching out the lower back and hamstrings) are feeling refreshed and calm. Some yogic texts state forward bends are good for relieving anxiety and insomnia.